The purpose of this proposal is to continue to implement a uniquely feasible approach to providing data relevant to the assessment of technology in medicine. The approach couples patient care integrated data acquisition with regular followup. It capitalizes on dollars already being expended in the patient care process to characterize the patient. Regular followup provides outcome data. We propose to continue this approach in the evaluation of patients with chest pain (suspected angina pectoris) and to demonstrate the applicability of the approach to other areas by extending it to the evaluation of patients with heartburn (suspected peptic disease). Initial characterization of the patient in terms of history, physical examination, laboratory tests, special proceduces (i.e., exercise testing, radionuclide angiography, cardiac catheterization, upper gastrointestinal barium studies and endoscopy), and treatment (both medical and surgical) will be captured in a computer record system by integrating this system with the patient care process. Outcome data will be obtained and added to the computer record system at appropriate intervals. These data will be analyzed using multiple regression-type models (i.e., multiple logistic regression model and Cox's regression model) and decision-type analyses to determine an appropriate strategy for the use, frequency and sequence of those tests which are of value and to establish a basis for eliminating tests which are unnecessary in a given patient. The approach presented in this proposal capitalizes on dollars already spent and is economically feasible across a range of institutions and disease.